#AskT-Bone – Ep39 – Sirona Semi-closed Platform vs. Open Platforms

All right! Welcome back for another episode of #AskT-Bone on the T-bone Speaks Podcast!

I hope everybody is doing well and looks like I’m back in the flow of releasing these #AskT-Bone segments.

Today we have a question submitted by Minol and it says:

I know you are a CEREC lover, but I have to ask. I just purchased a new practice and I’m in the market for a digital scanner. I want to use it for Crown and Bridges, possibly implants because I placed them as well, and for Invisalign scanning. I know Sirona has a closed platform however, products like iTero are open platform. Does this matter? And how should it affect my decision?

So let’s talk about this.

CEREC Chairside is a semi-closed platform. Listen, I’m making statements from my perspective not from Dentsply Sirona perspective, because I don’t know the exact marketing terminology, I don’t know the exact legality and terminology of this. But there are systems that are truly open and by open I mean you can take your digital impression and literally put it into any other software. Now, Sirona or CEREC is that and not that. So, what do I mean by that? Sounds like a politician’s answer.

The first thing I would ask you is why do you need an open system?What would an open system do for you?

That’s the first question, so if you are looking “hey I want to do crown and Bridges”, certainly CEREC can do that, so there’s no benefit of having an open system there. Teo, if you want to do implants in my opinion, no system is better than the Sirona system, before implants certainly with their Cone Beam and CEREC integration. And for Invisalign, CEREC also does Invisalign submissions to the CEREC Ortho Software. So if you said to me “hey that’s what I’m looking for” then I would say certainly CEREC is a great option. Now if you say to me “hey I don’t know what else I want to do”, then I would say could you do? What else is there that you may want to do in the future? So I think there’s a lot of people, a lot of Manufacturers, a competing products that will make this doubtingfor you, and look I am biased towards CEREC, I want to make that perfectly clear. But at the end of the day what I’m looking for, any time I make a purchase, I want that purchase to be good for me today and good for me tomorrow. So most people that buy digital impression systems, cameras that literally only send to Laboratories. I always ask them, do you ever think you’re going to mill? And they always say no and I always say that don’t say never say never. So I always look at this way: If I could buy a system and I have used that money to add on a milling unit why would I not want to do that? So I would say for example with iTero that is not an option for you. That you can’t mill in office with an iTero camera. So you would literally be buying a camera, I’m not saying iTero is good or bad, you would literally buy a camera that all they can do is take this Impressions. So, I would look at that as a negative. Same with 3Shape at this current time. You are buying a camera, although a very good camera that all it can do is take digital Impressions. It cannot mill, it cannot do any of those things at this point in time. So I look at that and I say why would you not want a system that would allow you to, if you decided to mill chairside, you don’t have to buy a whole brand new system, you literally can upgrade into a milling unit. So I look at that.

Now, on the chairside part of it, the reason what makes this Sirona system the CEREC system works so well is that it is a pretty close system. In other words you can take their images with their camera using their software and their milling unit and that’s all. For Chairside Restoration. That’s what makes it work, that’s what make it work all the time. That’s what, you know, we don’t have these issues of this system doesn’t work with that system, the cameras are communicating with the software, not communicating the milling. We generally don’t have those issues. And that is because it is pretty much a closed system on the chairside part of it.

Now what most people don’t understand and what, you know, the misinformation is out there, is that, when you get into using CEREC as a digital impression system. Now, whether you bought it as a standard low digital impression system or if you bought it as a chairside system you have digital impression capabilities. It’s called Sirona Connect. And how that works is you take a digital impression and then you can literally use the Connect software and send it to a Sirona laboratory. Now, once your Sirona laboratory gets it, they with their in-lab 15 software it becomes an open system. And what do I mean by that? They can take your digital impression, that can convert it to an STL file, which is a universal language that every software accepts. So it is a semi-open system. It is not open in the sense on the chairside part of it, but from the connect and laboratory side, as soon as I sent that to my third party laboratory, my Sirona laboratory, they’re able to convert that into a file that they can use with 3Shape with exocad with many of the other programs out there. And I know this for a fact because I work with Labs that utilize 3Shape for some of their more advanced restorative options, and they take my scans and convert them to 3Shape to use in a laboratory. So I think Sirona probably not doing a good enough job of marketing this capability, I think the other competitors are doing a somewhat disingenuous job of saying that the system is not open, but the truth is, I can take a digital impression with my CEREC camera and I can use it anywhere. It’s just a matter of knowing the right workflow and knowing how to make it happen, and not just believing what happens. So, it does involve the step of sending it to the laboratory with an in-lab 15, and they can convert it, exported out and do whatever they want with it. So I would say that it is an open system, I will just wouldn’t call it a completely truly open system, I called a semi-open system but it is open nonetheless.

So that is what I would say. So, doesn’t matter open vs. closed, I say 90% of time it doesn’t matter, 10% the time it does matter. And then does it affect your decision? I would base my decision more about long-term capabilities, the ability to mill in office. I think them while you’re a new practice that seems financially unfeasible to you at this point, or it seems like maybe you don’t want to do that. But I would say as your practice grows, as your patient base grows, as the patients become more aware of chairside single visit dentistry, I think there will be more and more pressure to be able to do chairside restorations. And I think and my biased opinion there is no better option than CEREC out there for that.

So thank you for submitting your questions and I encourage everybody listening to leave a review on iTunes for the T-bone Speaks Podcast and to also submit questions by visiting www.tbonespeaks.com Thank you very much!

2 Comments

You make some good points, but I want to play devils advocate. First I love the Cerec workflow. I started on the Bluecam and have used the Omnicam since 2013. It’s an amazing piece of technology and rarely have I taken a traditional impression since the Omnicam came out.

Having said that I don’t think it’s a semi-open system, I feel it’s closed. Sure you can scan something and send it to a lab, but you’re locked into a “Sirona” lab. Sure they can use inlab 15 software to extract the STL and manipulate it as they see fit, but that’s only open to them. Most labs aren’t going to turn around and give you a copy of the STL file for free, if you know one please let me know who it is.

People complain that Sirona isn’t open because we can’t readily have access to the STL file without jumping through major hoops to get there. We want access to the STL. I can’t speak for everyone, but I personally want the STL file so I can merge it into my cone beam DICOM. I use Blue Sky Plan, Blue Sky Bio’s FREE implant planning software. With that ability I can print in house my own custom surgical guide for $20. For most people it comes down to we want the freedom to control things how we want it, and then ultimately spend as little as possible.

I believe this is the freedom people want from an open system. Then they can purchase any CBCT, any digital scanner, and and 3D printer they want.

Literally time is not a factor. Just like learning the workflow for Cerec restorations there is an initial learning curve. Importing and exporting is simply opening/loading files just like any case you have, it’s not that complicated. Once the workflow is understood it can easily be done in approximately 10 mins. Obviously more complex cases can take a little longer. No matter what system you use it’s going to take that amount of time to plan your implant.

It’s so simple that any of your “champion” assistants can figure it out. Obviously you’ll have to review an approve it prior to printing a surgical guide. You of all people should understand that power of delegation and ownership that your champions take on.

You are right to each their own, but you can’t write off a system without trying it.